Morbidity and mortality from road injuries: results from the Global Burden of Disease Study 2017

BackgroundThe global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years.MethodsWe used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury.ResultsGlobally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change.ConclusionsWhile road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Achieving Educational Goals in Neurology Ward from the Viewpoint of Clinical Clerkship at Kermanshah University of Medical Sciences in 2012

In medical education, setting goals for clinical clerkship is the responsibility of educational groups. Taking the students' opinions into account, it is possible to study the efficacy of education in terms of learning and achieving educational goals. (1)In periodontics and restorative departments of Shahed and Tehran University of Medical Sciences, it is reported that, achieving educational goals is not poss-ible (2). Also, some studies have reported the inadequacy of educational objectives in anesthesia clerkship from the viewpoint of medical students (3). In this descriptive-analytic study, 166 medical students of neurology wards at Imam Reza Hospital in Kermanshah during 2011- 2012 were selected via a survey to study the achievement rate of educational goals. We used a questionnaire to collect data. Reliability of the questionnaire (including content and face validity) was obtained via consulting with ten faculty members of Kermanshah University of Medical Sciences.The mean age of the participants was 21.34 (±1.43) years. 60.5% of them were females. 3.6% were freshmen and 49.9% were sophomores. 79.5% knew the goals before the start of clinical clerkship and 76.5% took part in the justification session in which their responsibility and method of evaluation were presented. 78.3% of them received the emergency protocol of Neurology. Overall, the participants ranked the goal achievement as high (41.6%), well (45.2%) and medium (23.3%). There was no statistically significantly association between achieving educational goals and age and clinical clerkship period. However, there was a statis¬tically significantly association between the increase rate of achieving educational goals and introducing the objectives at the beginning of clinical clerkship period (p=0.011), justification session at the beginning of clinical clerkship (p=0.019) being familiar with emergency protocols of Neurology (p=0.04) and the season (winter in comparison with fall and spring) in which clinical clerkship took place (p<0.001) The high achievement rate in the issues like presence of the teacher and his/ her punctuality in the hospital (57.8%), his/ her punctuality during the clinical clerkship period (53%), and submitting morning reports were reported (51.8%). Low achievement rate was reported in the issues such as daily round cases and round quality (12%), employing applied topics in the class (9.6%) and class time table (3.23%).Education in emergency led to a rise in achieving educational goals in surgery clinical clerkship at Urmia University of Medical sciences (4). The Findings of this study are in line with those of this study. In the present study, increasing educational goals among students who knew about them before the clinical clerkship indicated that providing and introducing educational goals by instructors of the university and submitting them is important. These issues were also mentioned in a similar study in 2008 in Kermanshah (5). Thus, university instructors should pay special attention to this important educational principle. An interesting finding of the present study is the high achievement of educational goals by the students in winter. It seems that in this season instructors are fully present at their work place. The findings of this study also highlighted observing educational principles

Reliability and Validity of Objective Structured Clinical Examination for Residents of Obstetrics and Gynecology at Kermanshah University of Medical Sciences

Introduction: Objective structured clinical examination (OSCE) is used for the evaluation of the clinical competence in medicine for which it is essential to measure validity and reliability. This study aimed to investigate the validity and reliability of OSCE for residents of obstetrics and gynecology at Kermanshah University of Medical Sciences in 2011.Methods: A descriptive-correlation study was designed and the data of OSCE for obstetrics and gynecology were collected via learning behavior checklists in method stations and multiple choice questions in question stations. The data were analyzed through Pearson correlation coefficient and Cronbach's alpha, using SPSS software (version 16). To determine the criterion validity, correlation of OSCE scores with scores of resident promotion test, direct observation of procedural skills, and theoretical knowledge was determined; for reliability, however, Cronbach's alpha was used. Total sample consisted of 25 participants taking part in 14 stations. P value of less than 0.05 was considered as significant.Results: The mean OSCE scores was 22.66 (±6.85). Criterion validity of the stations with resident promotion theoretical test, first theoretical knowledge test, second theoretical knowledge, and direct observation of procedural skills (DOPS) was 0.97, 0.74, 0.49, and 0.79, respectively. In question stations, criterion validity was 0.15, and total validity of OSCE was 0.77.Conclusion: Findings of the present study indicated acceptable validity and reliability of OSCE for residents of obstetrics and gynecology

Analysis of Multiple Choice Tests Designed by Faculty Members of Kermanshah University of Medical Sciences

Dear Editor Multiple choice tests are the most common objective tests in medical education which are used to assess the ind-ividual knowledge, recall, recognition and problem solving abilities. One of the testing components is the post-test analysis. This component includes; first, qualitative analysis of the taxonomy of questions based on the Bloom’s educational objectives and percentage of the questions with no structural problems; and second, the quantitative analysis of the reliability (KR-20) and indices of difficulty and differentiation (1). This descriptive-analytical study was aimed to qualitatively and quan-titatively investigate the multiple-choice tests of the faculty members at Kermanshah University of Medical Sciences in 2009-2010. The sample size comprised of 156 tests. Data were analyzed by SPSS-16 software using t-test, chi-squared test, ANOVA and Tukey multiple comparison tests. The mean of reliability (KR-20), difficulty index, and discrimination index were 0.68 (± 0.31), 0.56 (± 0.15) and 0.21 (± 0.15), respectively, which were acceptable. The analysis of the tests at Mashad University of Medical Sciences indicated that the mean for the reliability of the tests was 0.72, and 52.2% of the tests had inappropriate difficulty index and 49.2% of the tests did not have acceptable differentiation index (2). Comparison of the tests at Kermanshah University of Medical Sciences for the fields of anatomy, physiology, biochemistry, genetics, statistics and behavioral sciences courses at Malaysia Faculty of Medicine (3) and tests at Argentina Faculty of Medicine (4) showed that while difficulty index was acceptable in all three universities, but differentiation indices in Malaysia and Argentina Medical Faculties were higher than that in Kermanshah University of Medical Sciences. The mean for the questions with no structural flaws in all tests, taxonomy I, taxonomy II, and taxonomy III were 73.88% (± 14.88), 34.65% (± 15.78), 41.34% (± 13.14) and 23.99% (± 15.40), respectively. Comparison of the variances of qualitative and quantitative indices indicated significant differences between difficulty index, differ¬entiation index, reliability of the total test and percentage of taxonomy II among faculties (P_value<0.001), but this differences were not observed in taxonomies I and III. The results of Tukey multiple comparison test revealed a statistically significantly increase in the reliability of the medical faculty tests (P_value=0.001) and a statistically significantly decrease in the difficulty index of paramedi¬cal faculty tests compared to other faculties (P_value =0.041). Due to the lower differentiation index, the per¬centage of taxonomies II and III and the percentage of the questions with no structural problems compared to the standard criterion in some faculties, it is necessary to provide qualitative and quantitative feedback for the faculty members, as mentioned in previous studies (5) to promote their knowledge in designing the multiple-choice questions as an assessing tool of students

New Methods of Evaluation for Postgraduate Training in Kermanshah University of Medical Sciences (2014)

Revered editor evaluation of medical students in specialized medical fields has great importance in determining the necessary competence to learning clinical environments and necessary ability for functioning in the real environment (1). New specialized medical evaluation focuses on ways that confirm the clinical competence assistant that can point to the students’ experience booklet (log book); assay exams; Multiple Choice Question (MCQ); Objective Structural Clinical Examination (OSCE); observation with check list or rating scale; self-assessment and assessment by peers rating scale general; Portfolio; Direct Observation of Procedure Skill (DOPS); Mini Clinical Evaluation Exercise (Mini-CEX); 360-degree comprehensive assessment of Clinical Skills based on Records assistants (CSR); Objective Structural Practical Examination (OSPE) (2). This descriptive-analytical study was performed to evaluate the use of modern methods of evaluation among eleven postgraduate departments in Kermanshah University of Medical Sciences in 2015. Data collection tool was a checklist that was prepared by researchers and was completed by clinical group managers. Data were analyzed with SPSS-16 software, Chi-square test and analysis of variance. In total of 11 studied groups, 106 full-time board faculty members, 14 co-education, 221 residents were working. The most modern methods to evaluate in %100 of groups were OSCE and MCQ, DOPS in %80 of groups, and Mini-CEX and CSR in% 27 of groups. Assay exams were used in infectious and pathology groups as the use of other modern methods of evaluation was not observed in all groups. Statistically, the most important reasons for the lack of significant new methods of evaluation were: internal decision of the department (P=0.002), unfamiliarity of team members with modern methods of evaluation (P=0.06), and the adequacy of other methods of evaluation according to the decision of the department (P<0.001). Other cited reasons such as lack of necessary accuracy of other methods to evaluate assistants and cost of time and money for the groups were not statistically significant. There is an extended use of the OSCE and MCQ in Kermanshah University of Medical Sciences in evaluating education assistants (3) and evaluation of five-year period of residency MCQ both quantitatively and qualitatively represents designer's assistant to the quality of exam questions in this type of methods (4). But considerable point in this study is lack of attention and unwillingness among faculty members in departments to use other new methods in evaluating the residents. This finding has also been reported in other universities of medical sciences (5), and it is proposed to hold effective and useful workshops to train and change point of views of faculty members about the new methods of evaluation practices

Factors Affecting Academic Failure in Nursing Students of Qom University of Medical Sciences: A Qualitative Study

Introduction: Academic failure of students is a major problem of higher education. The aim of this qualitative study was to explore the factors causing academic failure in nursing students of Qom University of Medical Sciences in 2015. Methods: This qualitative study was carried out via conventional qualitative content analysis approach. A total of 21 nursing students (18 males and 3 females) who had a Grade Point Average (GPA) lower than the previous semester and were conditioned (average 12) were selected through purposive sampling from the School of Nursing and Midwifery at Qom University of Medical Sciences. Data were collected through semi-structured face-to-face interviews conducted with each individual. Interviews were continued until data saturation, taking about 45 to 70 minutes. Data analysis was performed simultaneously with data gathering. Results: In this study, the mean age of participants was 21.9±4.1 year. Data analysis demonstrated that individual factors, factors related to curriculum, teaching methods of the faculty, large number of students in class, lack of formative assessment of teachers, lack of interaction between the faculty and students, and failure to comply with lesson plans were major causes of academic failure among students. Conclusion: Based on the results, managers, instructors and counselors can monitor their students' academic achievement by careful planning, active teaching methods and continuous assessment of students, and conduct individual and group counseling sessions to prevent academic failure